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susan swatek says

hi doug, I am wondering if you could advise me on what brand of pulley system you would purchase to do MET target tissue training in a small start up clinic. I am one of your past students. thanks for your time.

Hello! I currently have Medial compartmental OA in both knees. I have a Total Trainer which I have been using. My question is where and how should I place my feet? Should my toes be pointed straight, inward or outward? Should my feet be placed together or at the outer edges of the plate? Thank you for any advice you could give me.

I book your book on arthritis. You say that “If you know you have patellar tendonitis, meniscus tear, ligament injury, a subluxing patella, or a condition other than OA or CP, the solutions for these conditions are different than what I present in this book.” Could you direct me to information on solutions to meniscus tears?

Hello Stephen – thank you for your note. I wrote an article about how I healed my own meniscus tear – that might be helpful. The challenge with meniscus tears is the size of the tear, where the tear is in the meniscus and the stability of the tear. Small, stable tears tend to respond fairly well to the approach outlined in my books but in general I suggest working with a practitioner who can guide you. Usually meniscus tears need assistance from either injections or surgery and physical rehab to heal.

I just wanted to say I bought the 90 Day Osteoarthritis Remedy about 90 days ago, after my good knee suddenly got much worse than my bad knee. I could hardly walk, and I’m still working at teaching mathematics in China . I knew I really needed to change, and I knew this was the way. I found your book reading Saving My Knees by Beddard. That book gave me hope but not method. Using your book, first of all I restored my good knee to better than it was, maybe better than it’s been for years. More than that, I strengthened my core and my balance, and I have a set of exercises which I intend to continue doing. I particularly like your idea of rest, so I do the exercises every third day. I also viewed the videos to make sure I was doing the exercises right. I’m 70 years old. Your book was a life-changing experience, and it worked exactly as you said it would. So I want to acknowledge you as the expert you are and thank you.

Hello Russael – Thank you for your note and I’m thrilled to hear of your success. Well done! Thank you for taking time to let us know…made my day. If you can stick with a regular routine, your knees will thank you for years to come and it sounds like you’re on your way. Again, thanks much.

Hello Lucy – either the HOVR or the Mini-Bike can work. It depends on your physical environment. If you sit at a desk most of the day, then you might find the HOVR to be easier to work with. If not, then the mini-bike might be a good choice.

Hi DK,
I’m a 33 year old fitness junkie who destroyed my knee back in 2009 from a car accident. I had my PCL, ACL, LCL repaired with cadaver ligaments. In 2016(from overdoing it at gym-probably plyometrics did it) I tore my meniscus. I had a partial menisectomy and it was great up until about a month ago. I, of course, was feeling great and kept increasing my loads with squats and lunges and like that, after one leg day my leg has been hurting every since. Mostly the medial side with constant throbbing, crepitus(which my knee usually has), burning. Im thinking its my meniscus again. My question is what is your opinion on BFR therapy? I did it after my first meniscus surgery and it maintained my muscle beautifully while I healed. I did it on straight leg raises, quad sets and light weight leg press. I go back to my doctor next week. Im so frustrated with myself over this!
Thank you

Hi Chastity – thanks for your question and I’m sorry to hear of your recent struggles. As for BFR (blood flow restriction), that has some promise for people who need muscle conditioning but whose joints can’t take the loads required. However, the lower rate metabolic tissues of the joint need low load, high volume work in addition to the muscle training, my two cents. Good luck with your recovery.

Hi Doug,
I have a long history of chondromalacia in both knees from cycling and running. I’ve done PT for years starting back in the late 90s. I learned to manage the pain and continue to be active, until last year when constant pain and swelling made me stop being active. I’m in my late 40s and have quickly lost muscle mass over the past year. I need to really re-learn patience and focus so I can attempt to get back on the bike. I have both the runner’s knee bible and the 90 day knee arthritis books. My question is what is the difference between a sports PT and orthopaedic PT? Which would be best for me? Or is there something specific I should look for in a PT? I’ve been given the same exercises over the years that I lost faith in the system.
And I will be sure to start working on the quad sets again.
Thanks.

Hi Chad – thanks for your note. The Sports and Orthopedic PT is a designation of their respective specialties. There is some overlap in knowledge and skills though. If you’ve not had a professional assessment of the fit of your bike, I would get that done. Sometimes a small adjustment can have a large impact on the forces in the knee. As for as PT, you need someone who understands mechanobiology (how exercise alters tissue healing) and functional movement. If you would like to talk to my colleague Laurie Kertz Kelly about your situation, you can reach her at laurie@kertzcoaching.com

Thanks for your question. I understand your viewpoint and until recently, there wasn’t much proof behind the idea of intermittent fasting, A recent study, small in size, suggests that restricted feeling can help reduce blood pressure and excess bodyweight. You can find the study here: fasting study

Hi Michael – you found the person I suggest. As far as fat pad irritation, that’s generally not a large enough topic for a book. Sometimes it occurs in isolation and a steroid injection works well. But many times it’s the outcome of a number of other factors and you would need a professional to help you figure it out.

Thanks for your question. Yes, I have had a number of clients with that type of injury and surgery. I would get in touch with a physical therapist who is certified in orthopedic physical therapy or familiar with the surgery. You can start with this website to locate someone near you: http://aptaapps.apta.org/findapt/default.aspx?Unique=&UniqueKey=

I do not have knee pain, but crepitus – I hope to avoid getting pain by addressing this now. I would like to run more, but do not want to stress my knees too much either. Nutritionally I have already informed myself, so I am mostly interested into a good exercise guide. The Runner’s knee bible seems to be interesting, or would you rather recommend the 90 day knee arthritis remedy? The two books do appear to have some overlapping content.

Hi Andrea – thank you for your question. Crepitus can appear for a couple of reasons but the most common one is that the protective fluid in the knee – synovial fluid – is a bit too thin. I’ve found the certain exercises seem to improve the crepitus and quality of the fluid or thickness. The 90 Day Knee Arthritis book would be a good source of info (and yes there is some overlap between that book and the Runner’s Knee Bible).

Dear Doug – I was recently diagnosed with bilateral PFPS and into week 5 of acute phase. I am trying to follow your low load/high intensity advise for recovering from this awful condition. I get up and walk between 100-200 steps every 30min or so. No pain when walking BUT delayed mild pain and swelling/feeling of fullness on the top patella band (towards femur) from around 2pm daily. The simple exercises PT gave me (mainly straight leg VMO’s) aggravate the knees also. I am desperately trying to break this cycle of inflammation but still cannot work out what is causing the aggravation – any suggestions?

Hi Lili – sorry for the delay. I missed your question somehow. Usually, delayed pain and swelling is a sign of too much activity and / or load. Instead of walking, I might try sliding your foot back and forth on the floor on a paper plate. Just a minute or 2 once or twice a day and then assess how your knee responds. I can’t get into a lot of detail here – not the place and not proper without a history, interview, etc. If you need more help, contact my colleague Laurie Kertz – laurie@kertzcoaching.com. She might be able to assist you.

Hello, Thank you so much for your article. I’m a believer that your body is designed to heal itself if you give it the right tools to do so. Like you, I have a hard time believing that cartilage will not repair itself. I have taught spin classes for years and I also teach a low impact boot camp, and have been physically active the majority of my 54 years young. I’ve been limping and in pain for 4mo now and just received my MRI results….Ugh! A torn hip Labrum. Anybody out there that have used your protocols for healing a labrum? Im determined to prove people wrong here…it is possible to heal this tear! No surgery for me!!!

Hi Maria – a torn labrum is a different kind of cartilage injury than the joint surface and therefore needs a different approach than what I use to help strengthen articular cartilage. The labrum is a stabilizer of the joint and a different kind of cartilage as well. Some people recover without surgery, some have had PRP (platelet rich plasma) injections and rehab and do well. Some need surgery. It depends on how large the tear is and where it’s located. I hope this is helpful to you.

First of all thank you so much for the work you do. I have recently purchased the runners knee bible and a total trainer and I have just started your knee recovery programme. My question is: do the foot slider/tail gaiter/ t-trainer? Squats thicken ALL of the cartilage or just the part in the range of motion practiced? I ask this because although my diagnosed patellofemoral pain syndrome has all but gone when going up/down stairs, I do get a crackling noise and pain ( delayed ache) when extending out my leg from a heel-to-butt position even when lying on my back. Note: I can only actually get my heel within about 6 inches of my butt because the pressure in my knee feels worryingly highly and begins to hurt.
Sorry I couldn’t keep the message shorter.
Thanks again.
Paul (England)

Hello Paul – the goal of joint strengthening exercises is to stiffen the joint surface or make the joint surface more durable and improve the viscosity of the fluid in the joint. The cartilage may or may not change thickness. What matters most is what you can do on your leg. There are several reasons why you might experience what you describe. One of those is that the joint fluid that is too thin but without an assessment I can’t say with any certainty. Generally, motion improves as the joint health improves.

Hi! Thanks for all information you have given us.
I would like to know if you recommend any doctors and/or physical therapists in Brazil.
Also, I’d like to know your opinion about insoles. I used one (for flat fleet) and it worsened my knee pain a lot in one knee. My physical therapist said it’s because I used for a long period of time in the beggining and it’s normal to have pain until my body adapts.

I’m sorry – I don’t know of any therapists or doctors in Brazil. Inserts can be helpful and there is often a period of adaptation so I usually suggest wearing them a few hours and gradually increasing the time.

My wife, late 50s, has started doing super-slow weight training and is now experiencing knee pain. I’ve just bought your book – the 90-day remedy. Should she stop the super-slow training, or can you provide some guidance how it should be done?
Thanks / Derm – Balls! I have not said that already!

Hello Derm – you’ll find the answers in my book but if the first step is to remove the offending activity so if exercise is causing pain, I would not do the exercise generally speaking. Super Slow is harder on joints because the load is sustained over a longer time period and the concept is to go to extreme fatigue. I generally advise people to “leave a little in the tank” when it comes to fatigue. This article explains how I approach fatigue: http://dougkelsey.com/strength-training-for-champions/

My wife, late 50s, has started doing super-slow weight training and is now experiencing knee pain. I’ve just bought your book – the 90-day remedy. Should she stop the super-slow training, or can you provide some guidance how it should be done?
Thanks / Derm

Thanks Doug! Thinking about getting PRP in my osteochondral lesion of the medial talar dome and a smaller lesion on the tibial plafond, but it seems there’s no standard way to formulate the PRP yet? Can you suggest a good way? What do you think of multiple PRP shots over a period of time? Thanks again!

Hi Bill – yes, there is variability by the practitioner with PRP including the injection itself. I think guided injection (using ultrasound for example) makes more sense than unguided. Your question about multiple injections is a good one and something that would take too long to answer in this venue but I’ll put together an article about it soon. Thanks.

Hi Ben –
Thanks for your question. Stem Cell Therapy won’t resurface the knee in exposed bone situations but it has helped people feel better and be more active. The explanation for that reaction to Stem Cell Therapy has to do with how stem cells help regulate the biochemical environment of the knee.

Hi Doug,
I just purchased your ebook on knee pain. Looking forward to trying to help with a significant knee injury. You recommend fish oil. Have you seen the latest studies linking fish oil with aggressive prostate cancer? For many years I used to take fish oil. Then moved to krill oil. Have now eliminated both and take flax seed oil. Thought you might want to update your recommendations. Sincerely, Eric

Hi Doug,
I’m interested in buying the 90 day solution for knee pain you offer. My quick question is would it work for bruised articular cartilage damage? My gut tells me it would but wanted to check first. If not is there another approach you offer that I can follow? Specifically I have had an impact injury to my cartilage that prevents me from running. I miss my running, jumping, and all my high impact cardio exercises. It’s been nearly a year since the injury. Standard PT didn’t help much.

Impact injuries to the cartilage result in a weakened joint surface. The book discusses how to build joint strength and explains the science behind it. The exercises are different than those used to improve muscle strength (which are important to include). Impact injuries take a long time to heal even with optimal programming – it’s the nature of the injured tissue. I hope this helps.

We have an office in the Marathon Bldg in Austin, Tx (4111 MARATHON BLVD, AUSTIN, TX 78756). I’m not taking new clients presently. You can contact Laurie Kertz to inquire about her coaching services (she and I work together). Her email: laurie@kertzcoaching.com

Hi Skip –
I haven’t used the device but am familiar with the concept. I suspect it feels good. You can achieve a similar effect by using a partially inflated beach ball (see the image below)….gently, slowly turn your head right (should take about 3 seconds) to the middle (3 seconds) to the left (3 seconds). If you do this a few times a day for 3 minutes each time, you might be surprised how much better your body feels.

Reading through the 90 day .. book. I like the bit about pain management and the ritual you went through. I may want to speak to your staff. How do I go about doing this? The book so far had educated me no ends. It’s only once I started having these nigles that I reallized how much we take our body parts for granted.

Thanks. I came to your web site by way of Richard’s book. I will keep everyone posted how I progress and will download the recommended book.

Not sure what ‘s wrong with this knee but I look forward with a positive mind.

Thanks for sharing your knowledge. Buddha ( am a buddhist), said the sharing your knowledge is the best gift that one can give. Not money, not food, not clothes, not shelter. Knowledge empowers. Blessed are those who freely give their knowledge. That you do.

You have three books. I want to make sure I am buying the right book to answer question about my knee. I am 60 years old and until now had no problems with my knees.At no point do I feel continuous pain. There is some instability ( mainly when walking – I don’t try to run) after we moved house a month ago. So which book should I go for?

I was pleased to find an article on the web by you about cartilage – meniscus. I have had a problem for one year. It is nearly corrected! Your article has given me one more “secret” toward becoming 100% on that knee without surgery. Want to know more?

Hi Doug, do you have any recommendations for doctors and/or physical therapists in the New York City area who follow your way of thinking about cartilage regrowth? I am frustrated by the focus on my quad muscles and general pessimism. Please let me know of anyone who comes to mind! I would be so grateful.

Hi – thanks for your note. I don’t know of anyone in the NYC area. But one thing you can do is ask about the practitioner’s approach to joint surface injuries. When some practitoners (and some of the public too) hear “heal” a cartilage injury, they think “regeneration”. Even the term “regrowth” will be associated with regeneration. Cartilage has the ability to heal and become stronger – plenty of science behind that concept however, articular cartilage does not regenerate. The healing is closer to a scar. With a minor scratch, the skin will regenerate itself. You can’t see any evidence of the injury. But with a larger injury, you will have a scar. I would inquire about how a practitioner uses exercise to help a joint surface injury. If the answer is only muscle training, then you at least know the approach. And by the way, muscle strengthening is an important part of the process….just not the only part.

Hi Doug,
After a couple of years of off and on ankle pain, I got an xray that showed an osteochondral lesion of the medial talar dome. The pain wasn’t that bad, so I didn’t do anything about it. I got xrays every couple of years and it looked unchanged. I finally got an MRI 5 months ago. It showed a 9x24mm osteochondral lesion of the medial talar dome and a tibial plafond lesion measuring 6x11mm. There are some cysts as well. I agree with you that cartilage can heal, even though the doctors and PT’s I’ve talked to disagree. I was planning on getting off of it for 6 to 8 weeks to see if that might help it heal up, since I’ve never gotten off of it. 20 years ago, I had a medial meniscus tear and 2 surgeons wanted to do surgery, but I took glucosamine and chondroitin and swam and stationary biked for 6 months and went to a 3rd surgeon. She poked and prodded and said there was no way my meniscus was still torn, so I figured the same regimen might work for my ankle. I was forced into getting off of it 3 weeks ago when I went stand up paddle surfing for 4 hours and couldn’t hardly walk afterward. I’d only been off of the ankle for about 8 days when I got another MRI done to make sure I didn’t tear anything or have a fracture. I didn’t, so I decided to go ahead and stay off of it for a couple of months to see if the cartilage might heal. The 2nd MRI shows significant improvement in bone marrow edema, and some of the cysts looked better, but the lesions were still there. I’ve been swimming every day for 5 months to keep everything moving while I was still walking on it. Now that I’m off it, I’m still swimm every day, but am looking into cold laser and infra red light as a way to help it heal. Your PRP idea sounds encouraging as well. I’ve been taking glucosamine and chondroitin and a bunch of other supplements for 5 months as well. Yesterday I came across your article that cartilage can heal and am wondering if I shouldn’t stay off of it for that long without weight bearing. I don’t have arthritis and I’m 60 years old and don’t want it to get worse if I live to be 90 or 100. The gutter spaces are still pretty good as well. My idea was, if I have a lesion, why would I continually mash on it every day without first giving it a period of rest so it can try to heal? What do you think?

Bill – Most providers use the word “heal” and “regenerate” interchangeably. This is why many people believe joint surface injuries can’t “heal” …what they likely mean is regenerate. Joint surface injuries respond best to both controlled load and motion. Non-weight bearing for too long makes the joint surface weaker. So the challenge is finding a good balance of weightbearing, non-weightbearing, or even partial weightbearing with some activity that involves lots of repetitions. Stationary cycling sometimes helps..if you focus on moving the foot through the arc of motion.

Hi Dk! I travel for extended periods of time with my husband for his job. (I’m a writer, so my work goes with me!) I’m working on building strength using a kettle bell, but the kettle bell can’t go on a plane with me. How do I keep myself in shape? I don’t want to purchase one of the books if it doesn’t give me ways to do this without equipment. Can you tell me if one of them addresses this and if so, which one? Thanks! I love your blog!

My books won’t be of help to you. They are not general fitness books. But your question is a good one. Most hotels now have fitness rooms and almost all have dumb bells. You could get this attachment –> https://goo.gl/bRkF4h which turns a dumb bell into something a lot like a kettlebell. If not that, then I would get a Grey Cook band (you can find them on PerformBetter.com). I have used them for years and because of the design, you can use them for hundreds of exercises. Hope this helps.

hi Jeff – thanks for your question. Labral tears, hip or shoulder, are more difficult to heal. It depends on the size and stability of the tear. Smaller, more stable tears have a much better chance of healing. This is also true for meniscus tears in the knee. The principles to promote healing are similar to joint surface injuries but have a greater emphasis on creating stability.

Hi Doug, I used to receive your Blog “The View” a number of years ago. Thankfully I saved a notebook of them so I could look you up again.. Today one of my therapists asked me why I stopped our staff from using the “superman” exercise for our low back clients and fitness clients. I said I had read a piece from you explaining that it was too much force on the lumbar spine to do so. So her question was how do we work on strengthening the back extensors if we don’t use this exercise. Can you please redirect me to the best answer to her question. I did not find the article you wrote on that subject, so I’m hoping you can help myself and our staff with this issue. Kathy Hammer PT

Thanks for following my writing…really appreciate it. Good question and one I will incorporate into a future article. For lumbar (and thoracic) extensors, the “Bird Dog” exercise will both challenge the extensor group while producing much lower spinal loads than “superman”. The research was done by Stuart McGill, PhD. Here’s a short video of the exercise – https://s3.amazonaws.com/fusionaustin/bird_dog.mp4 I hope that’s helpful.

Hi Anne –
I’ve not used the Indo Board but have used products similar to it. It’s a way to challenge your balance and in certain situations works fairly well. I tend to do simple things though first – like stand on one leg while brushing your teeth. Sounds easy but it usually is fairly tough to do. The small movement of the arm during the brushing forces you to counter it with your balance…and you’re working on two things at once 😉 Thanks for your question.

Hi Doug,
I have your books on knee healing and in one of them you mention a product called Hovr. It keeps the legs moving whilst sitting. I bought one for home and quite like it as I can small cycling type movements on it all day long without stressing my knee. I wonder if you had any further thoughts on this product or tried it yourself? My second question is that I seem to have meniscus degeneration but not a tear and have looked in prp injections but am confused as to whether the injection should go into the actual meniscus or just into the synovial joint fluid and then hopefully find it’s way to the meniscus. What’s your opinion?
Best Regards, Lee

Hi Lee –
I came across the HOVR in an article on the concept of NEAT – non-exercise activity thermogenesis. NEAT is one the the factors in altering metabolism. So as you sit at your desk, for example, and move your legs, your metabolism goes up. It’s surprising how well this works. When I saw the product, I thought it fit nicely into the concept of light, intermittent movement and would work well within the programming I developed for knee pain. As for PRP and meniscus, I had that done on my right knee. A good sized tear of the medial meniscus (degenerative tear). The injection was into the meniscus but also supporting tissues around the knee – some ligaments, fascia, tendons. It worked well.

Quick question, So I know of the knee sliders and tailgaters for knee joint “health”. There’s the rock and roll with the exercise ball for lower back disc. For all of us daily computer workers, is there also an equivalent motion for neck discs.

Good question and I’ll put an article together on it but for now, yes, there is an option for the C-spine. You’ll need a 12” beach ball and a chair.
– Lie down on the floor with your lower legs on the chair (the hips and knees will be about 90 degrees each).
– Place the beach ball, having inflated it with a small amount of air, under your head and neck. The amount of air is determined by what feels good to you when you rest your head on it.
– Now, tuck your chin a small amount and roll your head right and left. The pace should be slow..about 4 seconds to the right, 4 seconds to the starting position and 4 seconds left.
– Do this for 5 minutes 3-5 times a day.

Are you mad? Just tead your article pain is in your head, blah, blah!
Have you EVER had severe, cgronic intractable pain from a paradoxycal effect to spinal shots of corticosteroids? Along entire right side of your body 24/7.? Kept me bedridden for 8 MONTHS! Also created edema around my spine, creating a “dead” lef feeling so when I stood o. Leg, i fell so hatd mt left doir hit door jam and I beoke mt hip.
But back to your article: per you to imagine what it looks like:
A red hot, blazing fire traveling from my lower waist to my foot with sharp pins sticking me 24/7!
I “imagibrd” suicide because of the pain. And I have Always had a high level for pain. Took my first “pilll”, an aspirin when I was 35 !
You do a disservice to those of us who don’t gave cancer, but Zi can promise you, hurt as bad. I talked with cancer patients!
Got disgusted with Norco, am getting my morphine implant removed. After 65 years, I now use pot. It’s immediate, won’t knock me out, and has a very slow, if any, tolerance fir me! I was taking 12-15 10 mg. Norcos many days…not all. And no way they last 6 hrs…barely 4. But DEA and AMA had fo ruin that by making legitimate usrrs drug seekers!
Until you have walked in my shoes…don’t try to tell anyone they can think pain away…just because they can!t find proper words to describe it!
Sometimes there are no words…all one can do is cry and just want it fixed!

Thank you for sharing your experiences with me. I can’t imagine how difficult that must be for you.

Unfortunately, modern medicine has created the idea that there is “real” pain and “pain in your head” – implying that some pain is not real. That was not my intent with the article. Rather, that ALL pain is real and it all is processed in your brain.

To answer your question, yes I have experienced severe, unrelenting pain with significant disability. In 2008, I was in a skiing accident in which I sustained a severe injury to my lower back. As a result, I could not sit, stand, walk more than 10-20 feet, put on my pants or shoes for many months. I slept in an inversion table 2 hours at a time because I hurt too much to lie down. It took me five years to overcome.

I would never assume to know your experience just as you can’t know mine. I apologize if you found my article offensive. I had hoped it would be enlightening for people.

I want to thank you for your article on ‘how cartilage heals’ and your e-books on the knee – when i badly tore my meniscus you were one of the lone voices i found, online or in person,who said it could heal.. Using your advice from your e-book and also posture retraining via the Gokhale Method and Egoscue method, i did heal my meniscus tear and am now back to active living. The key was, as you said, going slowly as cartilage heals slowly. I really appreciate your work and putting out the information online.

hi there! I recently had an arthroscopy for removal of loose bodies in my left knee ! I’m diagnosed with OA to my both knee ! I stopped playing tennis and stopped road biking after diagnosis! my knees always bothered my after a tennis match ,but, not too much though, or when I got to flex my knee allthe way down to the floor, not too much pain though for the rest of the time! my OA is stage 3 !, and is an old one (I’m 47 oldyear) my surgeon said. I ignored the few signs over the years cause I didn’t have serious pain!,So my question is:
WHY MY OSTEOARTHRITIS Doesn’t really hurt like most of the people?

Hi Dragos – good question. OA is painful when the joint tissues or other surrounding tissues are inflamed or overloaded. It’s possible to have changes in the joint (which is called osteoarthrosis) but hurt / have symptoms sporadically.

Hello Doctor. Is there a way to know whether your knee pain is due to cartilage damage? I was diagnosed with Patell Femoral Disorder. I did PT for 4 months and have continued the recommended exercises/stretches for 5 months more. It helped a bit but my left knee continues to have sharp pain and aching. When the PT taped it, it was fine. I know my knee cap is out of alignment but I don’t see how the PT exercises help to fix that. I have been trying to follow the guidelines to get my kneecap to “track” properly but nothing seems to help. Thank you for any reply.

Without knowing more about you and conducting an examination, it’s difficult to say but most people I’ve seen, certainly over the age of 40, with Patella Femoral Disorder (sometimes also called Chondromalacia) have softening of the cartilage that covers the end of the bones. The pain in this case isn’t from the cartilage as it doesn’t have any nerve supply but from other structures (the underlying bone, the lining of the joint, tendons or ligaments). Your situation though is not uncommon and often responds to low intensity, low load but high volume exercise. You can find more info about this on my website. I hope this is helpful to you.

Several years ago, Christine helped me overcome a torn rotator cuff by using your Fusion program. It worked and I continued the Fusion program. In June, at age 79,I had open heart surgery. Because I was in good shape pre-operation, I am recovering very well and continue using Fusion exercises. I expect to be near 100% in a few months. Thank you!

Doug, I would think, posting your routines with explanations would be greatly appreciated by most of your followers, and while can’t speak for them, I for one if not many, would be willing to purchase them. Steve

I just purchased your Core Conditioning program and discovered I do 4 of the 7 “don’t do” exercises as part of my warm up. I first learned the drill in the military over 50 years ago and have continuously restarted it whenever sporadic motivation kicks in (every six months or so). During a recent restart a few weeks ago I experienced painful lower back pains for the first time, and think I must run out of reserves and gone over the “edge. After seeing a doctor and ruling out the more serious ones ailments, I think it was one of the four don’ts, which as simple as they are, probably triggered it. The pain has decreased and getting ready to restart when learned program and plan it to try out. Haven’t done the test yet but suspect mid Yellow. I was going to order the “ActiveAgeBlue Print as well, and disappointed to find it was no longer available . Do you know of a good comprehensive 30 minute program. (I have done many programs and find it difficult to do a good program within 30 minutes, and time and attaining thresholds have been one of the biggest reasons for setbacks.

Thanks for purchasing my book – hope it’s helpful to you. I’ve been thinking about how to answer your question re: programs. It’s a complex issue…although one might think working out isn’t all that complicated. But it is. I don’t know of any programs that don’t include exercises that are risky. Seems like there’s at least one. I can post some of the routines I use with explanations of why I do what I do if you think that might be helpful. Just let me know.

What is your opinion or experience with using trampoline rebounders to rehabilitate injured and arthritic knees? Do you think rebounding is as good for circulation and the lymphatic system as the rebounder companies seem to all advertise?

Trampoline rebounders can be helpful for people with sensitive or weak joints because of the reduced impact force while allowing for some degree of exercise intensity. Movement of almost any type helps the circulatory and lymph system so making claims that rebounding is better in some way is a stretch other than if the person was unable to exercise or move at all.

Do you know much about monovisc? I saw the surgeon yesterday and he suggested an injection of monovisc for an arthritic knee. Would you advise that? I see that it’s only been approved the end of Feb, and I’m not too keen on injecting anything into my body. Do you know much about it?

Monovisc is a synovial fluid supplement – it’s purpose is to improve the quality of the fluid and thereby reduce pain, stiffness and other symptoms associated with arthritis. It’s similar to Synvisc. I’ve had clients respond well and some not at all so those questions would be good to ask the provider who knows your situation and will be doing the injections.

Thanks, Doug. The orthopedic surgeon I saw, thought it might help, but I’m just nervous getting something injected in me. Kind of gives me the willies – so I think I’ll wait before trying it. I did read that it helps some but not others. It’s also very expensive but my medical plan covers 80% of the cost. I might try it at some point. Thanks.

Hi Doug, I bought your book on core training and it is fantastic! Would you have a book to recommend on upper body strength? I find all the machines at the gym a bit overwhelming and a good structured and safe program would be most welcome. Would have bought it if you had a book on the subject!

Hello Stephen – thank you for your feedback. I appreciate that. As for upper body conditioning, I don’t offer programming that is oriented by body area (upper, lower, chest, back, etc). My programming is oriented around natural, functional movements and is offered through my online course – the ActiveAge Blueprint. You can learn more about the course at http://dougkelsey.com/the-activeageblueprint

I have been doing much research on knee cartilage and different problems and conditions associated with arthritis
and one that I haven’t had much knowledge of is Loose bodies or floating small pieces of cartilage in the knee.
I was wondering what is your take on eliminating these fragments of cartilage WITHOUT knee arthroscopy.
Is there any hope of possible dissolving these or reabsorbing them?

Thanks for your question. There are two main types of loose bodies – stable and unstable. A stable loose body will usually not cause too much trouble. It’s when it becomes unstable and floats within the joint that you run into problems. If the loose body is small enough, it can be reabsorbed but in many cases they have to be removed surgically.

I have a 2cm x 2cm ulceration of the articular cartilage in my left knee, it is almost to the bone. There is also some deterioration of the cartilage under the patella. I am a 34 year old Physical Education teacher assuming that the damage is a result of high impact activity.

After reading your articles and Richard Bedard’s blog I am fully committed to helping my knees improve over the next 2 years. Do you think I should buy The 90 Day Knee Arthritis Remedy or wait until The Runner’s Knee Bible is re-released?

Thanks for your question. The 90 Day Knee Arthritis Remedy has the content your looking for. Although there is similarity between what you describe and Runner’s Knee Syndrome, the Runner’s Knee Bible has more of a focus on the issues that runners face and has more content organized around returning to running. Deep cartilage injuries can take a long time to recover and sometimes need additional interventions (injections, surgical debridement, grafting). It’s hard to know without first trying to improve the health and strength of your joint.

Thanks for your quick response. I have had surgical debridement just over a week ago and would now like to give my the knee the best chance of being able to heal as much as it can naturally. Thanks again.

Kimi – yes, the Runner’s Knee Bible covers how to use a Total Gym or Total Trainer in some detail. The book is currently being revised though. However, my book “The 90 Day Knee Arthritis Remedy” also covers how to use these devices for knee pain related to cartilage problems (which is what Chondromalacia is). You can learn more about it here: http://dougkelsey.com/knee-arthritis-remedy/

Doug,
What’s your opinion on Rippetoe’s Starting Strength book and program? Is it a good program for strength training novices? Are there any specific exercises you would add or cut from the program? (For instance, I heard a suggestion that the program doesnt do enough to promote rotator cuff stability and to add rows to compensate.) I am starting out after (well-recovered) back and hip injuries, and am interested in developing impeccable form and gaining strength to protect from future injury.

Thanks for your question. The “Starting Strength” program is designed for someone who is interested in barbell lifting which has its pros and cons. My philosophy is rooted in improving and maintaining movement and certainly strength is an important part of that. But, so is balance, mobility, stamina, power, coordination, speed. Here’s an article I wrote that might help explain what a good program needs to have in it – http://dougkelsey.com/good-training-program/

Just a quick question. Any suggestions for how to deal with stairs? I have a medial meniscus tear and stage 111 chondromalacia and I see the specialist in June. But my house has 7 steps that I have to go up and down, every time I leave the house. I have a dog and I do those stairs about 15 times a day – any thoughts? 🙂

Sue – you might try going up and down the stairs one foot at a time instead of foot over foot. Go up the stairs with the uninjured leg then the injured leg. Come down leading with the injured then the uninjured. It’s slower of course than foot over foot but it also gives you more control and reduces the loading on the injured leg.

Thanks, Doug. I so appreciate your answer. I’m really taking it easy – I’m walking every day – but being careful, hoping to avoid any kind of surgery and hoping my meniscus heals on its own. I was shocked about the stage 3 chondromalacia, because until I tore my meniscus (competing with my dog in dog agility) I have never had one lick of trouble or pain in this knee, so it stunned me to read my MRI results and see that, and then to discover that it was stage 3 – sheesh.

It’s a big topic to handle in a comment but generally, avoid hamstring stretches which seem to be what many people do (because their hamstrings tend to feel tight) and avoid twists of the trunk on the legs or legs on the trunk. As far as exercises, many of the ones in my book work well (Build a Rock Solid Core), you could also search my site for other examples, or do an Internet search for “stabilization” exercises – you’ll find a lot of examples, some better than others.

I was wondering if you had any opinions on hyaluronan injections (e.g. Synvisc) for the knee. Might such injections aid or interfere with cartilage repair? Have you seen any results in your patients, one way or the other? Thanks!

Yes, I’ve seen patients who have had Synvisc injections. Some do well while others do not. These are good questions for an orthopedist who has some experience with the injections. Also, there’s some more recent research using hyaluronic acid with peripheral blood stem cells or bone morrow concentrate with fibrin mixture that shows promise.

Are there general recommendations that can be made to strengthen cartilage? More specifically the labrum? Having surgery for multiple anterior dislocations, but wanting to know if there are supplements or nutritional choices that can strengthen a weak labrum.

I HAD AN ACL SURGERY . WITH GRADE 3 CARTILAGE DAMAGE. I HAVE SHARP PAIN left bottom of my rt knee when i keep my leg straight for long time. Is this due to cartilage damage. Can my cartilage heal . And I also had meniscus tear grade 3. What is the difference between cartilage and meniscus can both of these heal over time. Please do tell me .I wanted to buy your book . Can I get paperback edition of your book .
Thankyou

Adam – Currently, the Runner’s Knee Bible is in PDF only. Answering your questions is not possible in this venue. Generally, cartilage has healing potential but it depends on the severity of damage, location of damage, procedures used to facilitate healing; not a simple answer.

Thanku soo much for the reply. So detail of cartilage is given in your book and exercises. Sorry for too many question I have to be sure before buying ur book that it will cover my problem. I am not much of a runner but I want my knee to become good as before or at least close to it. Thank you soo much for your presious time.

I bought your book “Knee Bible” and read that. Great book!
However, my situation is very messy and bad and I don’t know where to start. I am hoping if you can please advise me. I really need your suggestion and advise.
I saw another orthopedic and he diagonst 2 problems in my knee – 1) Meniscus tear in posterior horn of medial and lateral meniscus (injuery happened 9 months ago, I was functional up until this rececnt flare up 6 weeks ago.. 100% bedridden.)
2) This second dr. said I also have chondromalacia. where as first dr. told this as patellofemoral pain.

I have extreme burning behind my knee and under my knee cap. taking “aleve” from last one month.. not much improvement. My knee cannot even tolrate less than 1 min walk or 2 min of furniture sliding with foot drill from the book.

I learned from you about PRP injection before going for a surgery for meniscus. But, due to this severe burning and flare up, I am not able to decide for PRP or surgery thinking it will increase my burning and flare up more.. Aleady it is ranging 5-9/10 , 10 being highest.

Can you please advise, suggest where should I start? Should I wait until this flare up is bit settled before going for PRP?
Is it advisble to take PRP with such a bad flare up?
Where is this severe burning coming from? What I need to do to calm this down? Resting from last 6 week and aleve has not helped much.
Is chondromalacia. and patellofemoral pain terms are same?

I am ready to do or pay anything to get out of this death spiral. I have heard a lot about you and specially from Richard’s book.

Doug – Purchased your Runner’s Knee Bible, and have been employing the exercises, and have also found the blog very informative. Can you please tell me your thoughts on Hoffa’s Syndrome, specifically whether or not chronic fat pad impingement is treatable without surgery? Thanks.

I’ve approached Hoffa Syndrome in generally two ways:
a) taping technique of the inferior patella along with load controlled, closed chain strengthening of the hip rotators and lower extremity
b) the above plus a corticosteriod injection of the fat pad.

Are you asking about the rocking chair as a CPM for the knee? If so, it’s not the best solution because the knee joint doesn’t move much and it’s bent most of the time during the movement of the chair. It’s better than not moving the knee although it can also make it worse if the joint surface happens to be soft or weak at the specific angle created by being in the chair.

I am (was) a runner and don’t have Runner’s Knee, but do have osteoarthritis in one knee (maybe as a late result of a skiing injury in my teens). I would love to one day run again. The orthopedist tells me it is “mild to moderate” and told me to find another exercise. My main goal is to avoid further degeneration and knee replacement. I’m thinking the exercise that I have been doing isn’t helping (i.e., muscle strengthening). Your philosophy and work give me hope that I might run again! I was wondering if your Runner’s Knee Bible would be appropriate for me. Thanks.

Iris – thank you for your question. The Runner’s Knee Bible was written to help people with PatelloFemoral Pain Syndrome (also called Runner’s Knee Syndrome) which is a cartilage problem similar to osteoarthritis. The book would be a good reference tool for you almost like a text book. The programming in it though is geared to more of the specifics of PatelloFemoral Pain Syndrome although many of the concepts and training techniques are used in programming for osteoarthritis.

Thanks, Doug. I bought the book and it’s great. I know you can’t advise me in my situation but, theoretically, it seems as if a person might apply the principals of joint healing to osteoarthritis with some success over a longer period of time. A person with a weak joint could try strengthening the joint using the principals you outline in the book. If other factors, such as poor mechanics and imbalances, etc. are corrected, do you think it’s at least possible to improve the cartilage (articulate and meniscal) to a point where the degeneration is stopped?

Iris – the progression of OA can be slowed and there’s some evidence suggesting that with the proper blend of exercise and nutrition, it may even be halted. The exercise though has to be within the joint’s “load tolerance” which I cover in the book. While biomechanics plays a role, the more important thing is your “biologic reserve” – the amount of force your joint can produce and / or absorb and still have some capacity left over. The bone underneath the cartilage reacts to the load and if the load is too great, the bone will harden and cut off vital nutrient supply to the cartilage. This is one of the reasons why “load tolerance” is so important.

Hi Doug,
I found your information from “saving my knee” blog and book when searching through internet from last seven month to find answers to my knee problem. I am very impressed by reading your articles about knee pain, and a regular reader of your post from last one month. Your article has given me something very important which I had lost, “hope to heal”. Thank you for all the work you do to help people like me.
I broke my meniscus working out on elliptical machine seven months ago. I thought gym exercises are good and starting going to gym; third week while trying to keep elliptical machine running with one straight leg – in order to pause after 1-2 minute of exercise on machine – , I felt strong pull in my left knee. The injury I thought was a minor sprain turned out to be one of the biggest health problems of my life. I had swallow and stiff knee for two months after the injury. No mobility at all, was bedridden for two three months. Saw few doctors in stanford and they said that there is no option other than bearing this pain and spend life like this because you broke meniscus which does not heal. Also, this condition will get worst as you age. When I asked how can I make it better or prevent it from getting worst, their answer was “nothing , it will get worst.
My life has stopped after my knee injury. I am 47 yr. old female. Feeling all time low and desperate to get some help. Your articles about cartilage healing have given me hope. But, I am looking for your guidance and help to make my knee better and get my life back, and ready to do anything to achieve it. I had not done anything else to abuse my knee other than this mistake in Gym not knowing it . Doctors gave me quards exercise and doing one knee standing 1-10 count exercise for 2 minute had thrown me back last week back to square one. I am bed ridden again. Too much burning in knee. Not able to even walk slowly.
My reports says: complex tear of the posterior horn of the medial meniscus. Tear of the free edge of the body of the lateral meniscus.
5 mm anteriorly projecting osteophyte arises off the proximal margin of the intercondylar notch, abutting the adjacent patella articular cartilage. Full thickness cartilage loss along the lateral patellar facet. Cartilage thinning and irregularity overlying the median ridge and medial patellar facet and lateral femoral condyle.
Can you please guide me with your feedback as what I need to do to heal my knee and get my life back. As I said, I am ready to do anything to get my life back. I wanted to ask this in some of your article by commenting it but could not find a way to comment there.

I cannot give personal, specific advice on the blog. It would not be appropriate nor would it likely work for you since a problem always has multiple factors to consider which cannot be determined via email, comment box, etc.

However, I can give you some general tips. First, I would investigate Platelet Rich Plasma (PRP) injections for your knee. The PRP injection uses growth factors that naturally occur in your blood to help stimulate tissue healing. Here’s an article I wrote about it from my personal experience:

Once you have a more optimal healing environment established via the PRP, then you may benefit from the principles and techniques I discuss in my book, “The Runner’s Knee Bible” (http:/runnerskneebible.com) or secure the coaching services of someone who understands how to facilitate joint healing via special exercise techniques.

Thank you so much for your prompt reply and advice. I will buy your book “Runner’s Knee Bible” to gain more insight and apply those techinques for more recovery.
However, I do have one follow up question for you. I was able to resume my normal life slowly – slow walk, normal household work, going out for shopping etc. – after two-three month of rest after my original injury in April, 2013. However, I want to squre one two weeks ago just doing just 2 min. single leg standing quard exercise which tells that my cartilage are not healed yet or cannot take any load.

Can I give my body some more time – following Your book and “saving my knee” suggestions – to heal meniscus naturally and then decide for PRP injection after that? What do you suggestion?
Is meniscus and cartilage tear is same thing?
What is your contact email to discuss few specifics and get your suggestion? I am not sure about your consultation fee etc. though.

If you need my email to let me know all that in an email, please do let me know.

I cannot give personal, specific advice on the blog or via email. It would not be appropriate nor would it likely work for you since a problem always has multiple factors to consider which cannot be determined via email, comment box, etc. For consultations, please contact my colleague, Christine Springer.

Thanks so much for all of your valuable information. I’ve got collapsing arches and have been told that wearing orthotics is the only solution, that exercise alone will not resolve the problem. I’m not sure whether you have posted any information about this anywhere. I’ve read a lot of negative information about orthotics, that wearing them will weaken the intrinsic muscles and will make the problem worse. I’m not sure who’s right – the proponents of the barefoot/minimalist school or the podiatrists. I would be curious to know what you think about this..
thank you!

Else – thank you for your question. The answer is somewhat complicated but in a nutshell, the formation of the arch of the foot has several factors. Yes, the intrinsic muscles of the foot play a role but so does the position of the rear foot, position and movement of the hip, and the strength of the soft tissue in the foot. If you have foot pain and the you’ve been told it’s from “fallen arches” or “flat feet”, keep in mind that about 20% of adults have “fallen arches” and have no symptoms. I’ve used orthotics with my clients before to alter the force distribution through the foot while they retrain the strength of their soft tissue and work on improving their biomechanics. I don’t think you have to wear an orthotic forever necessarily.

Hi Doug,
I am suffering with chondromalacia and have seen a number of doctors and therapists over the last year.
Without fail, each one is suggesting that I work on my VMO. Your recent blog post on this subject really got my attention.

I am in Ontario, Canada. Do you know of any therapists/specialists in my province, that subscribe more closely to your thinking that the VMO cannot be isolated?

Sorry to hear about your knee. Unfortunately, I don’t know of anyone but I bet there are therapists or trainers who work from a movement model. Another thing to keep in mind is that cartilage needs a lot more reps, for example, than muscle. So, the person you see should have an understanding of cartilage physiology as well.

Can you advise on how to treat a shoulder impingement? I would love to get back to pushups and weight training but due to having this shoulder impingement now going on 6 months with PT(concentrating on posture only seems) my body has gone to mush. I was told that the impingement can cause back and neck pain both of which I do have as well now. I just want to get this shoulder back to norm so all this pain will be gone and I can start working out normally again with no pain.

Any advise on how to heal this darn thing would be greatly appreciated.

Shoulder Impingement can be caused by a number of things – rotator cuff tear / tendonosis, instability, scapular dyskinesis, lower trapezius weakness or myofascial tear among others. Once you know the possible cause(s), then the solution is easier to determine. Physical therapists who are board certified orthopedic specialists should have a good idea of how to help you. You can visit the American Physical Therapy Association website to locate a therapist in your area.

Thank you for your question. Generally, you could follow a post-platelet rich plasma injection protocol or one that is designed for cartilage repair. The cells following the procedure are fragile so you have to be careful how much force you use and how rapidly you progress the program.

Hi Doug,
I have been told that my RA is causing such a huge amount of inflammation that Cortisone and Supartz injections are not helping my knee pain. What are your views on how Rheumatoid Arthritis and Osteo Arthritis work together to cause knee pain? More importantly, the exercises that you prescribe, will they work even with RA? Or is there other specific treatment for RA affected knees?

While Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are different diseases, people with either tend to improve with joint friendly exercises. The key is getting the load levels correct. In the case of RA, I’ve found that the exercise routines must be customized to the person and adjusted frequently. The disease tends to wax and wane and as a result, the tolerance for load goes up and down. Consulting with an orthopedic certified physical therapist may be helpful to you.

I FEEL MY LOWER BACK (EXTREMELY STIFF AND PAINFUL IN MORNING – TAKES AN HOUR TO GET DISCS LOOSENED UP WITH HEAT, COLD, BATH, SWISS BALL, STRETCHING, ETC. – OR I CANNOT BEND FORWARD AT ALL) IS CAUSED BY SPINE LOSING FLUID IN DISCS. i’VE LOST HEIGHT. A FORMER RUNNER AND CURRENT TENNIS PLAYER, HIKER AND I WALK DAILY. ANY SUPPLEMENTS i CAN TAKE TO HELP BOOST THE LOST FLUID? (I DRINK ONLY GOOD SPRING WATER) AFFECTS MY NECK TOO. PROBABLY AGE CAUSING MY SPINE TO BE IMPACTED. HIPS ARE GETTING SORE TOO, ARTHRITIS? I’M OVER 60. HELP.

I was wondering if you know anyone in Oklahoma (Tulsa area specifically) with the same approach and mind set that you have. I am dealing with a hip problem that has become a back problem. The symptoms seem to be going back and forth.

I am a physical therapist myself but I am wanting someone to bounce ideas back and forth and get some guidance. It’s harder to do this alone. My “specialty is neuro based, hospital based and rehab work. Orthopedics is not my strength but I know the body and can understand the principles. I have read your blog for years and love your wisdom and approach.

I am thinking of joining active age blueprint soon…but I don’t want to perpetuate an injury. I think part of my problem is being a little bit too much inside my head and being scared to move. I need someone to push me a little bit.

My 16 yr old daughter plays club soccer. Recently several of her teammates have blown out their ACL – it wasn’t even under game play – they just tripped or slid on wet grass and Bam! Is your Running Program appropriate for helping prevent this injury? Soccer players have to make so many changes in direction.

There is a relationship between low hip strength and ACL injuries in young women. Your daughter would need a more customized program, assuming she has such weakness, than what is in my book “The Runner’s Knee Bible” or an off the shelf return to running program. Most sports/orthopedic physical therapists know about this issue and could help.

Hi Doug,
It’s been a long time since I crossed your path. Years ago I spent traveling back and forth from Houston to Austin for my shoulder – which of course, back in the day, you rehabilitated. Looking forward to joining the ActiveAge Blueprint. I believe THIS is what I’ve been looking for…can’t wait to post results down the road! Pam. p.s. Just ran across your blog the other day – it’s awesome!

Can you address bursitis, specifically of the greater trochanter? I understand that this can be a long term problem, and I am trying to do the right things which I have been told are stretching and strengthening the muscles around the hip. What are your feelings about cortisone injections in this situation? Do you see this condition much in cyclists?

Doug,
I saw an article you wrote in 2005 on dealing with Plantar Faciitis and you suggested using crutches for 2-3 weeks to let the ligament heal. My wife has been battling this for 3 months , but hasn’t tried crutches. Is that still the best advice

Bruce – for some people, crutches are needed. But it’s part of an overall strategy based on your weight bearing tolerance. I’m working on a series of articles now on the topic of plantarfasciitis that might help explain it. Too much info for a comment box.

Hey Doug. Before my question I just want to thank you because you give me hope in a world that is way to quick to write off problems as “just something you’ll have to deal with for the rest of your life”.

Anyway, can degenerative discs repair via motion and repetition? If so, what exercises do you recommend for degenerative discs?

About degenerative discs, in a nut shell the repair process is similar to a joint surface injury but because of the nature of the tissue involved, the program is different and too complex to answer here. One of the things you have to “reboot” is the stabilzer musculature. I wrote an article about that here:

Hey Doug! I love the way you describe about cartilage since no one else seems to say anything about it.

I have been diagonsed with a cartilage injury on my right knee medial femur chondyle size 2*1 cm (Grade II 50% OF CARTILAGE LEFT). No other knee problem. The injury is with approx 20 degree of flexion in the knee joint.
Running and jumping is completly impossbile at the moment.

I am trying to determine my load tolerance from your book but my knee is different. Since the injury is in 20 degrees I have pain when I am trying to sit down or if I use my knee over the 20% 0f flexion. Squatting etc.
I also get pain from walking up and down stairs.

I can easily do Static Hold in 90 degrees towards a wall for a couple of minutes
I can do back slides on my injured knee pain free (Maybe the injured area doesn´t disturb any other tissue in that excersise)
I can also sit in Third World Squat without pain.

I can change the load on my injured knee for example when squatting put the knees in slight valgus position or put the feets next to eachother (more lateral load since injury is madial)

Have you got any recommendations for how I should continue? Have you worked with similar patients?
I live in Sweden.

Bjorn – this is very difficult to do via a comment box but from what you describe, it seems as if you do have a load tolerance issue. If you hurt getting up and down from a chair, for example, then what I would do is test your leg using a variable incline plane as I described in the book (and I assume you mean The Runners Knee Bible). This will give you a threshold for load tolerance within the offending arc of motion. Once you know this, you can then find the optimal load level for reconditioning the joint. And yes, I’ve seen many people with similar problems. For more personalized help, email me and I’ll send you contact info for my partner, Christine Springer.

Kim – I think the best source for info about your surgery is the surgeon. While there is general info on the Internet, it doesn’t replace the back and forth question and answer that can come from a focused meeting with your surgeon. Most offices will have a process in place to facilitate answering common questions. This site has a number of FAQs that you might find helpful:http://drdumanian.com/pages/abdomen-hernia.html#rectus_diastasis

Hello.
I have a diastasis recti (from two pregnancies) and the beginnings of a ventral hernia. Am considering a hernia repair with the mesh as well as an abdominoplasty. I was wondering whether you could tell me anything about the surgery, or if you knew of any reliable references that I might read?
Many thanks in advance, and thank you for a great blog and ebooks!

When you have enough exposed bone, you won’t have enough cartilage to create a healing response. In some cases of a very small, focal area a microfracture technique can help but it sounds like you may have a larger area of exposed bone.

Have you heard of any physical therapists with your philosphy on healing knee cartilage in central IL? I’ve been told I need knee replacements for both knees as I am “bone on bone” in both. Trying to rebuild cartilage before going that route (57 yrs young) but need some help. The surgeons, PT’s and trainers I have been to tell me it is impossible. Thank you so much for your informative posts.

Have you heard of the slack line as a fun way to try to improve balance? Do you think it might be a good tool?
These folks in this video have really mastered the art of balance: http://www.youtube.com/watch?v=3MdDobR65Oo
I suspect they would have no trouble standing on one foot for a minute or even do the Tree Pose to Superman!
Lynn

Naomi – yes, I can say something about exercising in the Austin heat. It’s awful.

Having said that, make sure you’re well hydrated before you start, drink plenty of fluids both during and after. I train in my garage mostly or outside and typically drink at least 1 liter of water within a session – for example. Feeling drained later is often dehydration but could also be not eating enough of the right things so look at that as well. And yes, there’s an adaptation to training environments (heat, cold, wind, elevation, etc) but unless you must exercise in the heat, I would opt for more tolerable conditions.

Is there something you can say about exercising in the Austin heat? I find it puts a real dent in what I can do and not feel really drained later in the day. Is withstanding the heat part of conditioning? I do start early and drink much water along with electro-mix.

I found your article on back pain in the morning (‘flexibility is my friend’) very interesting. I have similar problems for about 5 years now, my doctor has examined my back and I have had an X ray scan of the back, there seems to be nothing wrong with the basic bone structure of the back. I believe the problems are with the muscles supporting the back The problems come early in the morning after 6 hours sleep. It seems that my back cannot take lying in the same position for that length of time. The muscles supporting the back then start to ache, and I am missing out on some sleep. The pain is not severe, its just enough to wake me up and then stop me from falling back to sleep again. During the day my back is fine, I feel no pain. My doctor says there is nothing more he can do for me here, he cannot explaiun why I am feeling pain early in the morning. I feel conventional medicine has failed me. I would like to get a referral to a sleep unit here in the UK, but to do so I would need to be referred by my doctor. But would a sleep unit be able to help me here? Are the problems best dealt with by a Physiotherapist or Chiropractor? Any advice considered!

Jonathon – from your description, it sounds like a Physiotherapist or Chiropractor would be the best choice. They might be able to assess sleep positions, sleep surfaces, your biomechanics. Another thing to consider that seems to affect some people is gluten. Some people are sensitive to gluten in their diet which causes a low grade inflammation. You could remove gluten from your diet for 6-8 weeks to see if there was any difference in your sleep quality / quantity.

What are your thoughts on a rope machine? I’ve been using a Marpo Vmx at the gym, and at home just 20 feet of heavy rope (not too heavy), which I use to strengthen my upper body and burn some calories. Since my knees are slowly healing, what I like is the ability to stand up and sit down, even walk around while I manipulate the ropes. so far it seems to be a good way to combine exercise forms and also to be able to work out at home outside while the weather is still good. Thoughts?

Patrick –
I’ve not used a Marpo Vmx so I can’t help you much there. The heavy rope drill can be a very demanding drill on the shoulders and trunk. It’s a function of the length and weight of the ropes. Since I don’t know the exact issue with your knees, it’s hard for me to say whether that exercise is one that could indirectly overload your knees. There is a reactive force from stabilizing the body – question is whether that force is too much or not.

The Bird Dog is part of a Priming sequence (I don’t believe it’s part of the assessment). Kneeling is not a contraindication but is a precaution. If kneeling is painful, by adding sufficient padding, you can relieve the discomfort. If your knee pain as from, for example, bursitis, then kneeling might be too painful to do but the book primarily addresses runner’s knee syndrome and kneeling is often tolerated.

Hi Doug- After many years of running five miles a day, I was diagnosed with chondrosis in my left knee and tendonitis in my right knee. I went through five months of physical therapy to strengthen my quads and hips and the therapy only made the pain worse. I had supartz injections in my left knee which had to be stopped after the second injection because I could no longer bend my knee without pain (I didn’t have that problem before the injection). I live in New Jersey and wanted to know if there are any therapists here who are familiar with your way of treating these problems (I can travel to New York City for one session as well). If not, do you have any reference materials that you provide to other therapists? Thank you.

I don’t know of anyone in the NJ / NYC area unfortunately. I know therapists who have purchased my book – The Runners Knee Bible (http://runnerskneebible.com) have told me that it was helpful in explaining the principles and concepts around joint related problems. You could also contact Christine Springer – look under the ABOUT tab on this site. She may be able to help you.

Without knowing exactly what was done surgically it’s hard to say what the cause is for your symptoms re: the sensation of something slipping. It may be that you have adhesions in the area which come into play when the knee is at certain angles. This could interfere with efforts to strengthen your joint since cartilage requires a very high volume of motion at low loads. The repetitive motion could irritate other tissue in your knee since the movement will not be smooth and unimpaired. I’ve sent people with complex knee issues to the Steadman Clinic in Vail, CO. They have a lot of experience with situations like yours.

I just did an Internet search to find out the best way to strengthen my quads because I had knee pain. The first article that jumped out astonished me–by Richard Bedard–refuting the very idea of doing that and describing the advice he got from you. My story parallels his so much in terms of what doctors have told me that I just assumed quad work was necessary–I had to do something! Always active, I nevertheless had four knee surgeries–two on each knee–once in my teens to add wood screws to hold the kneecap in place, and then in my forties to have the nails removed. The second op seems to have accelerated arthritis, which I had not known prior to it (not felt). For 12 years now it has been up and down. But I just assumed the cartilage would stay as it was–the MRIs showed marked deterioration when I had them filmed in Austin–where I lived a few years in 2003-2005. Just hearing the revelation that cartilage can repair itself–never having heard that ever before–is enlightening–for now that is how I will “talk” to my legs and knees–with awareness they have inner healing capacity–I am a believer in whole body and mind interconnection.

My question is in light of this last surgery when I had the nails removed. The doctor was a sports doctor in CA. He said it was a casual op. But it wasn’t. He added three inches to the scar on the right knee that was already long enough. And advised no physical therapy after the operations on both knees (done at the same time). I saw the wood screws–astonished they looked like screws for cabinetry! And he told me after the surgery ( with irritation) that he had a devil of a time getting the tendons or ligaments back in place. He said something about pulling them around. Now, years later, one thing I feel every time I get up from having my legs straight out or after sleep, and try to bend my knees, is first a kind of motion inside around the knee as if the ligament or tendon is sliding over into a new location. As if it settled almost on the knee cap and then moved aside. It wasn’t until recently I even remembered his saying he had done that. So could this fact affect healing, too? is there anything I can do about it while approaching the cartilage healing Mr. Bedard has presented from your advice?

I guess even to know what it is the doctor did, based on his description, would help. And whether it might have accelerated the apparent atrophy that has slightly bowed the legs.

Another way I could describe the sensation is that when I bend my knees even slightly to get up, it’s like there is a rope blocking the bone that eventually a few seconds later slips to the side.

Hi Doug
I watched a BBC Horizon documentary recently (no, not the Fast diet) about the human body clock. One aspect of this they talked about was the best time of the day to exercise (as I recall this was mostly in reference to “cardio” exercise.) Something that interested and worried me was the claim that cardio in the morning not only had no benefit on blood pressure but was also dangerous. Your blood pressure is naturally higher in the morning and putting more pressure on the heart at this time is asking for a heart attack. I usually prefer to run in the mornings and now that I live in Houston, if I want to run outdoors, the morning is the only sensible option. I’d be interested in your opinion on this subject.

There was a study done a few years ago that suggested early morning exercise was potentially detrimental to people who had hypertension or cardiovascular risk factors. If you’re otherwise healthy, there’s this more recent study that shows early morning exercise is beneficial: http://www.news.appstate.edu/2011/06/13/early-morning-exercise/

Doug: Thanks again for the help! Dale has an office in Southlake and I look forward to meeting him shortly.
(Didn’t know this was a public access. Could my contact info in the first message be removed before Google harvests it? Thanks)

Lacey: I want a non-surgical solution and I’m very much willing to cruise down to Austin if this doesn’t work out locally. Thanks for the feedback. I’m looking forward to my own success story!

Hi Doug:
I called your office today to ask for a physical therapy referral in the Dallas Ft Worth area. I’m in Bedford. The office said the closest was Oklahoma. I wondering if there is someone in my area with a similar mindset as you?

I suffered a right ankle inversion dislocation from a ladder fall two and half years ago. I’ve developed PF and more recently for the last three months or so routine peroneal tendon pain. The young orthopedic doctor a recently saw has just put me back in my air boot for four weeks with an rx for physical therapy. He want’s to do do an MRI if not improved in 30 days. I have this feeling we are off on the wrong track. I am hopeful that I can rehab these issues with some effort on my part. I successfully self-rehabbed the same leg after a total knee replacement several years ago with good direction from my knee surgeon. I do know how to follow directions.

So, is there someone that can get me started in the right direction locally or can I do this on my own with remote direction from Austin? Since it’s kind of a tough commute to Austin.

Thanks for any help,
(65 y.o. that still wants to be active. Not riding the bike anymore and only light duty on the indoor recumbent till I have a plan in place)

You should see Marty Stajduhar – he’s in Bedford I believe at : http://www.texashealth.org/MeettheStaffbh
I’ve known Marty a long time. Smart guy, great skills and has an extensive background. Tell him I sent you.

Thanks for your question. Tackling something like patellar tendonitis is a broad subject and it wouldn’t be proper for me to give you specifics via this venue. I can give you some general guidelines that might help though.

There are a number of disorders that can cause anterior knee pain so you to be sure you have tendonitis and not something else like tendonosis, bursitis, or patellofemoral syndrome or referred pain. But assuming you have a tendon injury, you have a couple of options.

Tendons heal from applied physical stress – either a low load over a long duration or a higher load and fewer reps. If you have symptoms at rest or soon after starting an activity, then you’ll need to go the low load, high rep path.

Biomechanics come into play too – adequate range of motion of the hip and ankle, enough strength in the hip to prevent too much rotation at the knee, etc but these these have to be evaluated by a health practitioner.

There are some good taping techniques that seem to help with symptoms and sometimes improve mechanics – you can look into kinesiotaping and probably find a practitioner near you.